DOCSLIB.ORG

Carbon Monoxide Poisoning in the Home Cyril John Polson

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Carbon Monoxide Poisoning in the Home Cyril John Polson Journal of Criminal Law and Criminology Volume 44 | Issue 4 Article 15 1954 Carbon Monoxide Poisoning in the Home Cyril John Polson Follow this and additional works at: https://scholarlycommons.law.northwestern.edu/jclc Part of the Criminal Law Commons, Criminology Commons, and the Criminology and Criminal Justice Commons Recommended Citation Cyril John Polson, Carbon Monoxide Poisoning in the Home, 44 J. Crim. L. Criminology & Police Sci. 531 (1953-1954) This Criminology is brought to you for free and open access by Northwestern University School of Law Scholarly Commons. It has been accepted for inclusion in Journal of Criminal Law and Criminology by an authorized editor of Northwestern University School of Law Scholarly Commons. CARBON MONOXIDE POISONING IN THE HOME* Cyril John Poison Cyril John Polson, M.D., F.R.C.P., is a Barrister-at-Law and Professor of Legal Medicine, University of Leeds, England. This article, the second of his to be published in this Journal, is based upon a public lecture delivered in the Uni- versity of Leeds, October 24, 1952.-EDIToR. Carbon monoxide poisoning in the home has for long been a common- place. It is clear, however, that so long as accidental poisoning con- tinues to occur there is room for recurrent reminders of the dangers of carbon monoxide. The present account is based on a detailed examination of the records of over 700 fatalities which have occurred during the past twenty five years in the City of Leeds. THE DANGERS PECULIAR TO CARBON MONOXIDE It requires no reflection to appreciate that any poison which is gaseous, and at the same time colourless, non-irritant and, may be, odourless, has grave potential dangers. Although coal gas, the usual source of carbon monoxide, has a distinctive smell there are a number of persons who are unable to detect its presence even in high concen- tration. It may be they suffer from a cold in the head or have an impaired sense of smell because of age or some inherent defect. It must be recalled that the blood pigment, haemoglobin, the prime function of which is to abstract oxygen from the air for the nourish- ment of the body tissues, also has an affinity for carbon monoxide. This affinity, originally recognised by Claude Bernard, was shown by Haldane and Douglas, by personal test, to be almost exactly 300 times greater than the affinity between haemoglobin and oxygen (Haldane, 1931); subsequent estimations (Taylor, 1948) assess it as between 200 and 250 times. Therefore the blood, when presented with a mix- ture of carbon monoxide and air will take up carbon monoxide in preference to oxygen; moreover, this will continue so long as the at- mosphere contains carbon monoxide, or until the blood is saturated with it. Of its several dangers this cumulative effect is perhaps the most important. The practical consequences are that not only high but also low concentrations of carbon monoxide are dangerous. Even a concen- tration of only one per cent or 1,000 parts per 100,000 will kill those * I am indebted not only to H. M. Coroner, City of Leeds, Dr. A. J. Swanton and to Mr. Llewellyn Jones, H. M. Coroner of Flint for placing their records at my disposal, but also to officials of the North-Eastern Gas Board for information and in particular to Mr. Appleyard, Mr. Winter, and Mr. Armstrong. 531 CYRIL JOHN POLSON [Vol. 44 exposed to it for a brief period. When Haldane (1895) inhaled such a mixture the concentiation of carbon monoxide in his blood reached half saturation, a dangerous level, in 15 minutes and death would have occurred in under half an hour. Exposure to a concentration of only 150-200 parts per hundred thousand, for one to four 'hours, will pro- duce dangerous symptoms. H.M.Factory Department (1945) recom- mend that where men are to be exposed for several hours the concen- tration of carbon monoxide in the atmosphere can be up to and below 10 parts per 100,000 (0.01%). The cumulative effect of the poison also indicates removal of the victim from the poisoned atmosphere as the first and immediate step in rescue attempts. Delay even by minutes may make all the difference between the survival and death of the victim. The effects of oxygen want, which is the essential result of this poison- ing, are exaggerated by effort. Ataxia or unsteadiness is likely even at rest when the blood is half saturated, and an attempt to escape would then result in immediate collapse. It is common experience that persons fail to remember these dangers although their occupation compels a special knowledge and experience of carbon monoxide. One instance will suffice. An acquaintance, who is a heating engineer and a former member of a mines rescue team, nearly lost his life because he did not remember the danger created by exhaust fumes of a motor car in a closed garage. One evening during the last war he had to effect some repairs to his motor car; the garage doors were closed to prevent any light showing outside. After a time he switched on the engine to test it. Presumably he was intent upon the results of his work and then, feeling unwell, he realised he was poisoned by carbon monoxide. He managed to stagger to the garage doors before he collapsed, and, fortunately, they were insecure and burst open under his weight. The escape of light from the garage attracted attention, and he was found lying unconscious in the drive. The speed with which a dangerous situation can arise in such circum- stances has been ascertained by experiment. The engine of a 20 H.P. motor car will produce a cubic foot of CO per minute and therefore it requires half an hour or less for the atmosphere to become lethal, when such an engine is run in a closed garage of average size (Hender- son & Haggard, 1927). This was confirmed by tests with a five-seating motor car, the engine of which, when run for twenty five minutes in a closed garage of 2,950 cu.ft. capacity, raised the concentration of CO in the atmosphere to 1.319%; at the end of an hour the concentration was raised to 2.1% (Yant, Jacobs, and Berger, 1924). 1953] CARBON MONOXIDE POISONING THE INCIDENCE OF CARBON MONOXIDE POISONING In recent times fatalities due to carbon monoxide poisoning in England and Wales have totalled about 2,000 each year. Except in respect of industrial accidents, accurate figures are not available con- cerning non-fatal poisonings. During the past 25 years there were 711 domestic fatalities in Leeds. The annual incidence ranged from 15 in 1930 to 52 in 1951 and averaged 28 per year, representing a rate of approximately 5.5 per 100,000 of the population. In industry, despite the wide use of carbon monoxide, often in odour- less mixtures, the annual accident rate is one of only about 220 cases each year and of these less than 10% prove fatal (H.M.Factory De- partment, 1945). Suicidal fatalities in Leeds accounted for 625 or 87.9% of the series; accidental poisonings totalled 60, or 8.4%, and there were 5 homicides, representing 0.7%. The remaining 21 deaths, or 3%, oc- curred in circumstances which led to an "open" verdict. It is probable that the Leeds experience is representative of that in other cities and urban areas; it is in close agreement with a London series of 838 fatalities (Camps, 1950). Amongst suicides, as is well recognized, carbon monoxide is the common mode; it is responsible for a third to nearly a half of all sui- cides, depending upon whether it is an urban or rural area, whereas the next choice, namely drowning, accounts for only a sixth. Suicide by poisons other than carbon monoxide, despite the increase in their use, accounted for only one tenth of the suicides and takes fourth place. There have been 1,372 suicides in Leeds during the past 25 years and of these 615 or 44.7% were by carbon monoxide poisoning, 242 or 17.6% by drowning, 173 or 12.6% by hanging, and only 144 or 10.5% by poisoning other than by carbon monoxide. The Pattern of Suicide. The essential features of suicidal poison- ing, as might be expected, either overtly or indirectly, show intent. ,They are sufficiently well known to require only a brief recapitulation. At least a third of the deceased leave letters, notes, or notices in which their intention to commit suicide is plain. Some are lengthy documents which, on occasion, may be written during the act and in which the subject records his sensations until he can no longer write. Others content themselves with the display of a simple warning notice of the presence of gas. Theoretically these documents could be forged by a person who sought to mask a murder by staging a suicide. It is, however, the general practice of Coroners to ask a relative or friend, CYRIL JOHN POLSON [Vol. 44 familiar with the handwriting of the deceased, to identify it. Although such persons are rarely experts in this difficult field, it is unlikely that they would be deceived by the clumsy forgery which is alone likely in such circumstances. The expert forger, an aristocrat of crime, rarely descends to murder. There is usually ample evidence of preparation, which is indirect evi- dence of intent. Few of these suicides omit some provision for their bodily comfort, although it be no more than a pillow or cushion for the head. It is rare that they inhale the gas in circumstances of positive discomfort.
Load more

Recommended publications
  • Title: Drowning and Therapeutic Hypothermia: Dead Man Walking
    Title: Drowning and Therapeutic Hypothermia: Dead Man Walking Author(s): Angela Kavenaugh, D.O., Jamie Cohen, D.O., Jennifer Davis MD FAAP, Department of PICU Affiliation(s): Chris Evert Children’s Hospital, Broward Health Medical Center ABSTRACT BODY: Background: Drowning is the second leading cause of death in children and is associated with severe morbidity and mortality, most often due to hypoxic-ischemic encephalopathy. Those that survive are often left with debilitating neurological deficits. Therapeutic Hypothermia after resuscitation from ventricular fibrillation or pulseless ventricular tachycardia induced cardiac arrest is the standard of care in adults and has also been proven to have beneficial effects that persist into early childhood when utilized in neonatal birth asphyxia, but has yet to be accepted into practice for pediatrics. Objective: To present supportive evidence that Therapeutic Hypothermia improves mortality and morbidity specifically for pediatric post drowning patients. Case Report: A five year old male presented to the Emergency Department after pool submersion of unknown duration. He was found to have asphyxial cardiac arrest and received bystander CPR, which was continued by EMS for a total of 10 minutes, including 2 doses of epinephrine. CPR continued into the emergency department. Upon presentation to the ED, he was found to have fixed and dilated pupils, unresponsiveness, with a GCS of 3. Upon initial pulse check was found to have return of spontaneous circulation, with sinus tachycardia. His blood gas revealed 6.86/45/477/8/-25. He was intubated, given 2 normal saline boluses and 2 mEq/kg of Sodium Bicarbonate. The initial head CT was normal.
    [Show full text]
  • Traveler Information
    Traveler Information QUICK LINKS Marine Hazards—TRAVELER INFORMATION • Introduction • Risk • Hazards of the Beach • Animals that Bite or Wound • Animals that Envenomate • Animals that are Poisonous to Eat • General Prevention Strategies Traveler Information MARINE HAZARDS INTRODUCTION Coastal waters around the world can be dangerous. Swimming, diving, snorkeling, wading, fishing, and beachcombing can pose hazards for the unwary marine visitor. The seas contain animals and plants that can bite, wound, or deliver venom or toxin with fangs, barbs, spines, or stinging cells. Injuries from stony coral and sea urchins and stings from jellyfish, fire coral, and sea anemones are common. Drowning can be caused by tides, strong currents, or rip tides; shark attacks; envenomation (e.g., box jellyfish, cone snails, blue-ringed octopus); or overconsumption of alcohol. Eating some types of potentially toxic fish and seafood may increase risk for seafood poisoning. RISK Risk depends on the type and location of activity, as well as the time of year, winds, currents, water temperature, and the prevalence of dangerous marine animals nearby. In general, tropical seas (especially the western Pacific Ocean) are more dangerous than temperate seas for the risk of injury and envenomation, which are common among seaside vacationers, snorkelers, swimmers, and scuba divers. Jellyfish stings are most common in warm oceans during the warmer months. The reef and the sandy sea bottom conceal many creatures with poisonous spines. The highly dangerous blue-ringed octopus and cone shells are found in rocky pools along the shore. Sea anemones and sea urchins are widely dispersed. Sea snakes are highly venomous but rarely bite.
    [Show full text]
  • Asphyxia Neonatorum
    CLINICAL REVIEW Asphyxia Neonatorum Raul C. Banagale, MD, and Steven M. Donn, MD Ann Arbor, Michigan Various biochemical and structural changes affecting the newborn’s well­ being develop as a result of perinatal asphyxia. Central nervous system ab­ normalities are frequent complications with high mortality and morbidity. Cardiac compromise may lead to dysrhythmias and cardiogenic shock. Coagulopathy in the form of disseminated intravascular coagulation or mas­ sive pulmonary hemorrhage are potentially lethal complications. Necrotizing enterocolitis, acute renal failure, and endocrine problems affecting fluid elec­ trolyte balance are likely to occur. Even the adrenal glands and pancreas are vulnerable to perinatal oxygen deprivation. The best form of management appears to be anticipation, early identification, and prevention of potential obstetrical-neonatal problems. Every effort should be made to carry out ef­ fective resuscitation measures on the depressed infant at the time of delivery. erinatal asphyxia produces a wide diversity of in­ molecules brought into the alveoli inadequately com­ Pjury in the newborn. Severe birth asphyxia, evi­ pensate for the uptake by the blood, causing decreases denced by Apgar scores of three or less at one minute, in alveolar oxygen pressure (P02), arterial P02 (Pa02) develops not only in the preterm but also in the term and arterial oxygen saturation. Correspondingly, arte­ and post-term infant. The knowledge encompassing rial carbon dioxide pressure (PaC02) rises because the the causes, detection, diagnosis, and management of insufficient ventilation cannot expel the volume of the clinical entities resulting from perinatal oxygen carbon dioxide that is added to the alveoli by the pul­ deprivation has been further enriched by investigators monary capillary blood.
    [Show full text]
  • Failure of Hypothermia As Treatment for Asphyxiated Newborn Rabbits R
    Arch Dis Child: first published as 10.1136/adc.51.7.512 on 1 July 1976. Downloaded from Archives of Disease in Childhood, 1976, 51, 512. Failure of hypothermia as treatment for asphyxiated newborn rabbits R. K. OATES and DAVID HARVEY From the Institute of Obstetrics and Gynaecology, Queen Charlotte's Maternity Hospital, London Oates, R. K., and Harvey, D. (1976). Archives of Disease in Childhood, 51, 512. Failure of hypothermia as treatment for asphyxiated newborn rabbits. Cooling is known to prolong survival in newborn animals when used before the onset of asphyxia. It has therefore been advocated as a treatment for birth asphyxia in humans. Since it is not possible to cool a human baby before the onset of birth asphyxia, experiments were designed to test the effect of cooling after asphyxia had already started. Newborn rabbits were asphyxiated in 100% nitrogen and were cooled either quickly (drop of 1 °C in 45 s) or slowly (drop of 1°C in 2 min) at varying intervals after asphyxia had started. When compared with controls, there was an increase in survival only when fast cooling was used early in asphyxia. This fast rate of cooling is impossible to obtain in a human baby weighing from 30 to 60 times more than a newborn rabbit. Further litters ofrabbits were asphyxiated in utero. After delivery they were placed in environmental temperatures of either 37 °C, 20 °C, or 0 °C and observed for spon- taneous recovery. The animals who were cooled survived less often than those kept at 37 'C. The results of these experiments suggest that hypothermia has little to offer in the treatment of birth asphyxia in humans.
    [Show full text]
  • The Post-Mortem Appearances in Cases of Asphyxia Caused By
    a U?UST 1902.1 ASPHYXIA CAUSED BY DROWNING 297 Table I. Shows the occurrence of fluid and mud in the 55 fresh bodies. ?ritfinal Jlrttclcs. Fluid. Mud. Air-passage ... .... 20 2 ? ? and stomach ... ig 6 ? ? stomach and intestine ... 7 1 ? ? and intestine X ??? Stomach ... ??? THE POST-MORTEM APPEARANCES IN Intestine ... ... 1 Stomach and intestine ... ... i CASES OF ASPHYXIA CAUSED BY DROWNING. Total 46 9 = 55 By J. B. GIBBONS, From the above table it will be seen that fluid was in the alone in 20 LIEUT.-COL., I.M.S., present air-passage cases, in the air-passage and stomach in sixteen, Lute Police-Surgeon, Calcutta, Civil Surgeon, Ilowrah. in the air-passage, stomach and intestine in seven, in the air-passage and intestine in one. As used in this table the term includes frothy and non- frothy fluid. Frothy fluid is only to be expected In the period from June 1893 to November when the has been quickly recovered from months which I body 1900, excluding three during the water in which drowning took place and cases on leave, 15/ of was privilege asphyxia examined without delay. In some of my cases were examined me in the due to drowning by it was present in a most typical form; there was For the of this Calcutta Morgue. purpose a bunch of fine lathery froth about the nostrils, all cases of death inhibition paper I exclude by and the respiratory tract down to the bronchi due to submersion and all cases of or syncope was filled with it. received after into death from injuries falling The quantity of fluid in the air-passage varies the water.
    [Show full text]
  • Respiratory and Gastrointestinal Involvement in Birth Asphyxia
    Academic Journal of Pediatrics & Neonatology ISSN 2474-7521 Research Article Acad J Ped Neonatol Volume 6 Issue 4 - May 2018 Copyright © All rights are reserved by Dr Rohit Vohra DOI: 10.19080/AJPN.2018.06.555751 Respiratory and Gastrointestinal Involvement in Birth Asphyxia Rohit Vohra1*, Vivek Singh2, Minakshi Bansal3 and Divyank Pathak4 1Senior resident, Sir Ganga Ram Hospital, India 2Junior Resident, Pravara Institute of Medical Sciences, India 3Fellow pediatrichematology, Sir Ganga Ram Hospital, India 4Resident, Pravara Institute of Medical Sciences, India Submission: December 01, 2017; Published: May 14, 2018 *Corresponding author: Dr Rohit Vohra, Senior resident, Sir Ganga Ram Hospital, 22/2A Tilaknagar, New Delhi-110018, India, Tel: 9717995787; Email: Abstract Background: The healthy fetus or newborn is equipped with a range of adaptive, strategies to reduce overall oxygen consumption and protect vital organs such as the heart and brain during asphyxia. Acute injury occurs when the severity of asphyxia exceeds the capacity of the system to maintain cellular metabolism within vulnerable regions. Impairment in oxygen delivery damage all organ system including pulmonary and gastrointestinal tract. The pulmonary effects of asphyxia include increased pulmonary vascular resistance, pulmonary hemorrhage, pulmonary edema secondary to cardiac failure, and possibly failure of surfactant production with secondary hyaline membrane disease (acute respiratory distress syndrome).Gastrointestinal damage might include injury to the bowel wall, which can be mucosal or full thickness and even involve perforation Material and methods: This is a prospective observational hospital based study carried out on 152 asphyxiated neonates admitted in NICU of Rural Medical College of Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra from September 2013 to August 2015.
    [Show full text]
  • Respiratory Physiology for the Anesthesiologist
    REVIEW ARTICLE Deborah J. Culley, M.D., Editor ABSTRACT Respiratory function is fundamental in the practice of anesthesia. Knowledge of basic physiologic principles of respiration assists in the proper implemen- tation of daily actions of induction and maintenance of general anesthesia, Respiratory Physiology delivery of mechanical ventilation, discontinuation of mechanical and pharma- cologic support, and return to the preoperative state. The current work pro- Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/130/6/1064/455191/20190600_0-00035.pdf by guest on 24 September 2021 for the Anesthesiologist vides a review of classic physiology and emphasizes features important to the anesthesiologist. The material is divided in two main sections, gas exchange Luca Bigatello, M.D., Antonio Pesenti, M.D. and respiratory mechanics; each section presents the physiology as the basis ANESTHESIOLOGY 2019; 130:1064–77 of abnormal states. We review the path of oxygen from air to the artery and of carbon dioxide the opposite way, and we have the causes of hypoxemia and of hypercarbia based on these very footpaths. We present the actions nesthesiologists take control of the respiratory func- of pressure, flow, and volume as the normal determinants of ventilation, and Ation of millions of patients throughout the world each we review the resulting abnormalities in terms of changes of resistance and day. We learn to maintain gas exchange and use respiration compliance. to administer anesthetic gases through the completion of (ANESTHESIOLOGY 2019; 130:1064–77) surgery, when we return this vital function to its legitimate owners, ideally with a seamless transition to a healthy post- operative course.
    [Show full text]
  • MECAP News April 2021
    U.S. Consumer Product Safety Commission MECAPnews MEDICAL EXAMINERS AND CORONERS ALERT PROJECT April 2021 MECAP Reports | Page 2 Asphyxia/Suffocation Carbon Monoxide Poisoning Submersion MECAP Reports | Page 3 Fire All-Terrain Vehicles (ATVs) Electrocution Fatalities Involving Other Hazards MECAP Contact | Page 4 The following pages summarize MECAP reports Yolanda Nash received by CPSC selected for follow-up Program Analyst investigation. The entries include a brief Division of Hazard and Injury Data description of the incident to illustrate the type and Systems Directorate for Epidemiology nature of the reported fatalities. This important information helps CPSC carry out its mission to U.S. Consumer Product Safety protect the public from product-related injuries and Commission deaths. 4330 East-West Highway Bethesda, MD We appreciate your support; please continue to 20814 report your product-related cases to us. [email protected] 1-800-638-8095 x7502 or 301-504-7502 *Cases selected for CPSC follow-up investigation Asphyxiation/ down to sleep in a toddler basement stairs. The Suffocation bed with multiple heavy electric power had been blankets. The next morning, shut off, and the generator *A 7-year-old female was the mother found the was used to provide power. discovered by her mother decedent positioned face EMS measured the carbon unresponsive in bed with a down in the soft bedding monoxide level at 500 ppm. balloon pulled over her face. and blankets. Despite The cause of death was The decedent became emergency efforts, the carbon monoxide poisoning. entangled with a helium infant was pronounced dead balloon tied to her bed and at the hospital.
    [Show full text]
  • Perinatal Asphyxia Neonatal Therapeutic Hypothermia
    PERINATAL ASPHYXIA NEONATAL THERAPEUTIC HYPOTHERMIA Sergio G. Golombek, MD, MPH, FAAP Professor of Pediatrics & Clinical Public Health – NYMC Attending Neonatologist Maria Fareri Children’s Hospital - WMC Valhalla, New York President - SIBEN ASPHYXIA From Greek [ἀσφυξία]: “A stopping of the pulse” “Loss of consciousness as a result of too little oxygen and too much CO2 in the blood: suffocation causes asphyxia” (Webster’s New World Dictionary) On the influence of abnormal parturition, difficult labours, premature birth, and asphyxia neonatorum, on the mental and physical condition of the child, especially in relation to deformities. By W. J. Little, MD (Transactions of the Obstetrical Society of London 1861;3:243-344) General spastic contraction of the lower Contracture of adductors and flexors of lower extremities. Premature birth. Asphyxia extremities. Left hand weak. Both hands awkward. neonatorum of 36 hr duration. Hands More paralytic than spastic. Born with navel-string unaffected. (Case XLVII) around neck. Asphyxia neonatorum 1 hour. (Case XLIII) Perinatal hypoxic-ischemic encephalopathy (HIE) Associated with high neonatal mortality and severe long-term neurologic morbidity Hypothermia is rapidly becoming standard therapy for full-term neonates with moderate-to-severe HIE Occurs at a rate of about 3/1000 live-born infants in developed countries, but the rate is estimated to be higher in the developing world Intrapartum-related neonatal deaths (previously called ‘‘birth asphyxia’’) are the fifth most common cause of deaths among children under 5 years of age, accounting for an estimated 814,000 deaths each year, and also associated with significant morbidity, resulting in a burden of 42 million disability adjusted life years (DALYs).
    [Show full text]
  • Near Drowning
    Near Drowning McHenry Western Lake County EMS Definition • Near drowning means the person almost died from not being able to breathe under water. Near Drownings • Defined as: Survival of Victim for more than 24* following submission in a fluid medium. • Leading cause of death in children 1-4 years of age. • Second leading cause of death in children 1-14 years of age. • 85 % are caused from falls into pools or natural bodies of water. • Male/Female ratio is 4-1 Near Drowning • Submersion injury occurs when a person is submerged in water, attempts to breathe, and either aspirates water (wet) or has laryngospasm (dry). Response • If a person has been rescued from a near drowning situation, quick first aid and medical attention are extremely important. Statistics • 6,000 to 8,000 people drown each year. Most of them are within a short distance of shore. • A person who is drowning can not shout for help. • Watch for uneven swimming motions that indicate swimmer is getting tired Statistics • Children can drown in only a few inches of water. • Suspect an accident if you see someone fully clothed • If the person is a cold water drowning, you may be able to revive them. Near Drowning Risk Factor by Age 600 500 400 300 Male Female 200 100 0 0-4 yr 5-9 yr 10-14 yr 15-19 Ref: Paul A. Checchia, MD - Loma Linda University Children’s Hospital Near Drowning • “Tragically 90% of all fatal submersion incidents occur within ten yards of safety.” Robinson, Ped Emer Care; 1987 Causes • Leaving small children unattended around bath tubs and pools • Drinking
    [Show full text]
  • Perinatal Asphyxia in the Term Newborn
    www.jpnim.com Open Access eISSN: 2281-0692 Journal of Pediatric and Neonatal Individualized Medicine 2014;3(2):e030269 doi: 10.7363/030269 Received: 2014 Oct 01; accepted: 2014 Oct 14; published online: 2014 Oct 21 Review Perinatal asphyxia in the term newborn Roberto Antonucci1, Annalisa Porcella1, Maria Dolores Pilloni2 1Division of Neonatology and Pediatrics, “Nostra Signora di Bonaria” Hospital, San Gavino Monreale, Italy 2Family Planning Clinic, San Gavino Monreale, ASL 6 Sanluri (VS), Italy Proceedings Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014) Cagliari (Italy) · October 25th, 2014 The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken Abstract Despite the important advances in perinatal care in the past decades, asphyxia remains a severe condition leading to significant mortality and morbidity. Perinatal asphyxia has an incidence of 1 to 6 per 1,000 live full-term births, and represents the third most common cause of neonatal death (23%) after preterm birth (28%) and severe infections (26%). Many preconceptional, antepartum and intrapartum risk factors have been shown to be associated with perinatal asphyxia. The standard for defining an intrapartum hypoxic-ischemic event as sufficient to produce moderate to severe neonatal encephalopathy which subsequently leads to cerebral palsy has been established in 3 Consensus statements. The cornerstone of all three statements is the presence of severe metabolic acidosis (pH < 7 and base deficit ≥ 12 mmol/L) at birth in a newborn exhibiting early signs of moderate or severe encephalopathy. Perinatal asphyxia may affect virtually any organ, but hypoxic-ischemic encephalopathy (HIE) is the most studied clinical condition and that is burdened with the most severe sequelae.
    [Show full text]
  • Mild Hypothermia After Near Drowning in Twin Toddlers Ortrud Vargas Hein1, Andreas Triltsch2, Christoph Von Buch3, Wolfgang J Kox1 and Claudia Spies1
    Available online http://ccforum.com/content/8/5/R353 ResearchOctober 2004 Vol 8 No 5 Open Access Mild hypothermia after near drowning in twin toddlers Ortrud Vargas Hein1, Andreas Triltsch2, Christoph von Buch3, Wolfgang J Kox1 and Claudia Spies1 1Department of Anesthesiology and Intensive Care Medicine, Charité, Campus Mitte, Humboldt University, Berlin, Germany 2Department of Anesthesiology and Intensive Care Medicine, Benjamin Franklin Medical Center, Free University, Berlin, Germany 3University Department of Pediatrics, University of Heidelberg, Mannheim, Germany Corresponding author: Ortrud Vargas Hein, [email protected] Received: 28 January 2004 Critical Care 2004, 8:R353-R357 (DOI 10.1186/cc2926) Revisions requested: 13 April 2004 This article is online at: http://ccforum.com/content/8/5/R353 Revisions received: 14 May 2004 © 2004 Vargas Hein et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Accepted: 24 July 2004 Creative Commons Attribution License (http://creativecommons.org/ Published: 2 September 2004 licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction We report a case of twin toddlers who both suffered near drowning but with different post-trauma treatment and course, and different neurological outcomes. Methods and results Two twin toddlers (a boy and girl, aged 2 years and 3 months) suffered hypothermic near drowning with protracted cardiac arrest and aspiration. The girl was treated with mild hypothermia for 72 hours and developed acute respiratory dysfunction syndrome and sepsis. She recovered without neurological deficit. The boy's treatment was conducted under normothermia without further complications.
    [Show full text]